Physician Variation in Lung Cancer Treatment at the End of Life

Details

• Alternative Title:
  Am J Manag Care
• Personal Author:
  Green, Jonas B. ; Shapiro, Martin F. ; Ettner, Susan L. ; Malin, Jennifer ; Ang, Alfonso ; Wong, Mitchell D.
• Description:
  OBJECTIVES
  
  To determine whether a treating oncologist’s characteristics are associated with variation in use of chemotherapy for patients with advanced non–small cell lung cancer (aNSCLC) at the end of life.
  
  STUDY DESIGN
  
  Retrospective cohort.
  
  METHODS
  
  Using the 2009 Surveillance, Epidemiology, and End Results–Medicare database, we studied chemotherapy receipt within 30 days of death among Medicare enrollees who were diagnosed with aNSCLC between 1999 and 2006, received chemotherapy, and died within 3 years of diagnosis. A multilevel model was constructed to assess the contribution of patient and physician characteristics and geography to receiving chemotherapy within 30 days of death.
  
  RESULTS
  
  Among 21,894 patients meeting eligibility criteria, 43.1% received chemotherapy within 30 days of death. In unadjusted bivariate analyses, female sex, Asian or black race, older age, and a greater number of comorbid diagnoses predicted lower likelihood of receiving chemotherapy at the end of life (P ≤.038 for all comparisons). Adjusting for patient and physician characteristics, physicians in small independent practices were substantially more likely than those employed in other practice models, particularly academic practices or nongovernment hospitals, to order chemotherapy for a patient in the last 30 days of life (P <.001 for all comparisons); female physicians were less likely than males to prescribe such treatment (P = .04).
  
  CONCLUSIONS
  
  Patients receiving care for aNSCLC in small independent oncology practices are more likely to receive chemotherapy in the last 30 days of life.
  
  
• Subjects:
  Antineoplastic Agents Carcinoma, Non-Small-Cell Lung Cohort Studies Drug Utilization Female Humans Lung Neoplasms Male Practice Patterns, Physicians' Retrospective Studies SEER Program Terminal Care United States

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• Source:
  Am J Manag Care. 23(4):216-223
• Pubmed ID:
  28554208
• Pubmed Central ID:
  PMC5762116
• Document Type:
  Journal Article
• Funding:
  HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; P20 MD000182/MD/NIMHD NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  23
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:b4f92dcc4b1ff2ded3881bfb95c48c58116d8bdd49b0161a6c82236ee9bc9d38
• Download URL:
  https://stacks.cdc.gov/view/cdc/50855/cdc_50855_DS1.pdf
• File Type:
  [PDF - 769.78 KB ]